Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density

Lee, S. J.; Binkley, Neil; Lubner, Meghan G.; Bruce, Richard J.; Ziemlewicz, Timothy J.; Pickhardt, Perry J.

doi:10.1007/s00198-015-3318-4

Cited by 164 publications

(117 citation statements)

References 20 publications

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“…(6) Previous work has shown that CT scans obtained for other indications can be used to assess BMD at the spine and may provide an acceptable initial screen. (7)(8)(9)(10) Although these CT vertebral measures can be used to identify those at highest risk for fracture, none provide 10-year fracture risk, which can truly guide when further workup and treatment is indicated.…”

Section: Introductionmentioning

confidence: 99%

Opportunistic Quantitative CT Bone Mineral Density Measurement at the Proximal Femur Using Routine Contrast-Enhanced Scans: Direct Comparison With DXA in 355 Adults

Ziemlewicz

Maciejewski

Binkley

et al. 2016

Journal of Bone and Mineral Research

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For patients undergoing routine contrast-enhanced CT examinations, an opportunity exists for concurrent osteoporosis screening without additional radiation exposure or patient time using proximal femur CT X-ray absorptiometry (CTXA). We investigated the effect of i.v. contrast enhancement on femoral neck CTXA T-score measurement compared with DXA. This cohort included 355 adults (277 female; mean age, 59.7 ± 13.3 years; range, 21 to 90 years) who underwent standard contrast-enhanced CT assessment at 120 kV over an 8-year interval, as well as DXA BMD assessment within 100 days of the CT study (mean 46 ± 30 days). Linear regression and a Bland-Altman plot were performed to compare DXA and CTXA results. CTXA diagnostic sensitivity and specificity was evaluated with DXA as the reference standard. There was good correlation between DXA and CTXA (r = 0.824 for both areal BMD and T-scores) and the SD of the distribution of residuals was 0.063 g/cm or 0.45 T-score units. There was no trend in differences between the two measurements and a small bias was noted with DXA T-score +0.18 units higher than CTXA. CTXA had a sensitivity for discriminating normal from low bone mineral density of 94.9% (95% CI, 90.6% to 97.4%). For opportunistic osteoporosis screening at routine post-contrast abdominopelvic CT scans, CTXA produces T-scores similar to DXA. Because femoral neck CTXA BMD measurement is now included in the WHO Fracture Risk Assessment Tool (FRAX) tool, this opportunistic method could help to increase osteoporosis screening because it can be applied regardless of the clinical indication for CT scanning. © 2016 American Society for Bone and Mineral Research.

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Section: Introductionmentioning

confidence: 99%

Opportunistic Quantitative CT Bone Mineral Density Measurement at the Proximal Femur Using Routine Contrast-Enhanced Scans: Direct Comparison With DXA in 355 Adults

Ziemlewicz

Maciejewski

Binkley

et al. 2016

Journal of Bone and Mineral Research

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“…Other imaging modalities that capture tissue densities include CT scans which measure signal attenuation in the form of Hounsfield units (46). Several studies have successfully correlated CT HUs to bone density for clinical applications (47)(48)(49)(50)(51)(52)(53)(54)(55).…”

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confidence: 99%

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation

Ford

Kumm

Decker

2019

Journal of Forensic Sciences

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Sex and age are two elements in the establishment of a biological profile for forensic identification. While the pelvic bones are the most ideal structures for sex estimation, the condition of a body is not always ideal due to the nature of death, such as in mass disasters, or postmortem processes. This study utilized CT scans and resultant 3D models of 100 male and 100 female adults of known ages ranging from 18 to 98 years old to collect volumetric and Hounsfield unit measurements of the proximal femur. Equations were created to establish logistic regression models for sex estimation and linear regression models for age estimation. The resultant sex estimation method had an accuracy of 93.5% and utilized the volume of the proximal femur. This study provides three linear regression models for age with an accuracy range of 86%–92% ±12 years. As imaging technologies are increasingly adopted for forensic purposes, the power of 3D data will provide the opportunity for more quantitative and reproducible analyses. The proposed method for sex and age estimation provides a reliable tool that can be utilized in both day‐to‐day casework and disaster victim identification.

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“…Although the obtained CT image also depends on the absorption of X‐radiation, in contrast to DEXA a 3D replication of the scanned object is produced using a standardized linear attenuation coefficient scale, where air is defined as −1,000 and water as 0, expressed in HU. Also, in human medicine, the use of CT scans obtained for other indications (e.g., CT colonography) to determine bone density is of high interest in current research . All these studies have in common the fact that the HU of a defined 2D region of interest (ROI) is measured in a single or in multiple slice(s).…”

mentioning

confidence: 99%

“…Measuring bone density with computed tomography instead of using dual-energy X-ray absorptiometry (DEXA) has become a focus of interest in the last few years in human and veterinary medicine. [1][2][3][4][5][6][7][8][9][10][11][12][13] However, according to the World Health Organization, the gold standard for quantitative measurements of bone density is dual-energy X-ray absorptiometry (DEXA). 14,15 Both modalities (DEXA and CT) are based on X-radiation.…”

mentioning

confidence: 99%

“…Also, in human medicine, the use of CT scans obtained for other indications (e.g., CT colonography) to determine bone density is of high interest in current research. [8][9][10][11][12][13]24,25,30,33,34 All these studies have in common the fact that the HU of a defined 2D region of interest (ROI) is measured in a single or in multiple slice(s). The reported correlation of bone density measured with CT (in HU) and DEXA ( BMD in g/cm 2 ) in human patients ranges between 0.44 and 0.77.…”

mentioning

confidence: 99%

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Comparative investigation of bone mineral density using CT and DEXA in a canine femoral model

Lucas

Behrens

Nolte

et al. 2017

Journal Orthopaedic Research

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Bone density measurements using computed tomography (CT) instead of dual-energy X-ray absorptiometry (DEXA) are currently of great interest in human and veterinary medical research as it would be beneficial to use CT scans obtained for other indications also for determining bone density. For Hounsfield units (HU) measured with CT in specific regions of interests (ROIs) in one or several slice/s a correlation with bone mineral density (BMD) measured by DEXA in humans and dogs of between 0.44 and 0.77 is reported in the literature. In the present study, instead certain volumes of interest (VOIs) obtained by CT scan and the corresponding HU to the respective VOIs were compared with the bone mineral density of the corresponding areas measured by DEXA. The aim of the study was to investigate whether this procedure gives more accurate information about bone density of the bones as three-dimensional objects of the respective patient. Correlation between measured HU in the respective VOI and BMD measured with DEXA in the corresponding ROI showed a very good correlation of 0.93. Linear regression with R = 0.85 (p = 0.0262) was calculated. Except for VOI5, similar distribution of values and significant differences (p < 0.0001-0.0087) between ROIs/VOIs were detected. Determining HU for assessing bone mineral density in a certain volume provides more accurate results than those previously reported from two-dimensional (2D) CT measurements. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2667-2672, 2017.

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Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density

Abstract: Assessment of the sagittal view alone at routine abdominal CT for both vertebral fractures and trabecular bone mineral density provides a rapid and effective opportunistic screen for detecting individuals at increased risk for fragility fractures.

Cited by 164 publications

References 20 publications

Opportunistic Quantitative CT Bone Mineral Density Measurement at the Proximal Femur Using Routine Contrast-Enhanced Scans: Direct Comparison With DXA in 355 Adults

Opportunistic Quantitative CT Bone Mineral Density Measurement at the Proximal Femur Using Routine Contrast-Enhanced Scans: Direct Comparison With DXA in 355 Adults

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation

Comparative investigation of bone mineral density using CT and DEXA in a canine femoral model

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